Long-term follow up of tandem autologous-allogeneic hematopoietic cell transplantation for multiple myeloma
Long-term follow up of tandem autologous-allogeneic hematopoietic cell transplantation for multiple myeloma
Blog Article
We previously reported initial results in 102 multiple myeloma (MM) patients treated with sequential high-dose melphalan and autologous hematopoietic cell transplantation followed by 200 cGy total body irradiation with or without fludarabine 90 mg/m2 and allogeneic hematopoietic cell transplantation.Here we present long-term clinical outcomes among the 102 initial patients and among Stainless Steel Spur with 1" Band and 9 Point Rowel 142 additional patients, with a median follow up of 8.3 (range 1.
0-18.1) years.Donors included human leukocyte antigen identical siblings (n=179) and HLA-matched unrelated donors (n=65).
A total of 209 patients (86%) received tandem autologous-allogeneic upfront, while thirty-five patients (14%) had failed a previous autologous hematopoietic cell transplantation before the planned autologous-allogeneic transplantation.Thirty-one patients received maintenance treatment at a median of 86 days (range, 61-150) after allogeneic transplantation.Five-year rates of overall survival (OS) and progression-free survival (PFS) were 54% and 31%, respectively.
Ten-year OS and PFS were 41% and 19%, respectively.Overall non-relapse mortality was 2% at 100 days and 14% at five years.Patients with induction-refractory disease and those with high-risk biological features experienced shorter OS and PFS.
A total of 152 patients experienced disease relapse and 117 of those received salvage treatment.Eighty-three of the 117 patients achieved a clinical response, and for those, the median duration of survival after relapse was 7.8 years.
Moreover, a subset of patients who became negative for minimal residual disease (MRD) by flow cytometry experienced a significantly lower relapse rate as compared with MRD-positive patients (P=0.03).Our study showed that the graft-versus-myeloma effect after non-myeloablative allografting allowed long-term disease control in standard and high-risk patient subsets.
Ultra-high-risk patients did not appear to benefit from Brush Set tandem autologous/allogeneic hematopoietic cell transplantation because of early disease relapse.Incorporation of newer anti-MM agents into the initial induction treatments before tandem hematopoietic cell transplantation and during maintenance might improve outcomes of ultra-high-risk patients.Clinical trials included in this study are registered at: clinicaltrials.
gov identifiers: 00075478, 00005799, 01251575, 00078858, 00105001, 00027820, 00089011, 00003196, 00006251, 00793572, 00054353, 00014235, 00003954.